The biologic and developmental problems of abused children are usually thought of etiologically in relation to the physical trauma which has been suffered. Indeed, physical trauma can cause death, brain damage, developmental delays and deviations in personality development. The environment in which the abused child grows and develops is a most important basis for both physiological and psychological wounds in these children. The child is apt to be exposed to a number of biologic high-risk factors, e.g., medical difficulties in pregnancy and labor and delivery, prematurity, and inadequate medical and nutritional care. There are also a number of traits and characteristics of abusive parents to which the child must adapt. Some of the most common and significant factors are unpredictability, social isolation, messages of lack of value, role-reversal, and absence of modeling of pleasurable social interaction. Finally, there are environmental hazards stemming from therapeutic interventions, i.e., hospitalization, frequent foster home changes, and long-term foster placement without termination of parental rights. There are various options available to the child to help him cope and adapt to such environmental stresses. Two case examples highlight the effect of the abusive environment on the developing child. (Author)